Provider Demographics
NPI:1962713164
Name:GUNTHERBERG, ANN SERIO (OPTICAN)
Entity type:Individual
Prefix:MRS
First Name:ANN
Middle Name:SERIO
Last Name:GUNTHERBERG
Suffix:
Gender:F
Credentials:OPTICAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 GRAND CANYON DR
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70131-8634
Mailing Address - Country:US
Mailing Address - Phone:504-394-0075
Mailing Address - Fax:504-394-0075
Practice Address - Street 1:65 GRAND CANYON DR
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70131-8634
Practice Address - Country:US
Practice Address - Phone:504-394-0075
Practice Address - Fax:504-394-0075
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-23
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician